ESPE Abstracts

Background: Children at type 1 diabetes (T1DM) diagnosis can develop ketoacidosis (DKA), a life-threatening condition, which is most frequently associated with the onset of diabetes in children aged <5 years.

Aims and objectives: We studied the prevalence of DKA at T1DM diagnosis and the frequency of partial remission (PR) in children from Wielkopolska province, Poland.

Method: The cohort comprised 735 children aged 0–18 years with newly diagnosed T1DM. Clinical and biological features were collected at diagnosis and during follow-up. DKA was defined as blood pH <7.30. To confirm autoimmune diabetes origin typical autoantibodies were tested. Questionnaire on diabetes was completed by children’s parents. PR was defined using the insulin-dose-adjusted A1C definition. P value <0.05 was considered significant.

Results: DKA was diagnosed in 36.0% of patients: 12.9% had mild form, while 14.5% and 8.7% moderate and severe, respectively. In children aged 0–4, 5–9, 10–14 and 15–18 years DKA was present in 48.5, 34.7, 31.4 and 28.2%, respectively. In individuals aged <4 years DKA occurred significantly often (P=0.001). The highest severe DKA frequency was associated with symptoms’ duration (>28 days) (P=0.014) and diabetes misdiagnosis (P=0.001). ZnT8 autoantibody was detected significantly often in children with DKA (P=0.44). Children with DKA had higher levels of blood ketones (P=0.0001), HbA1C (P=0.0004), blood glucose (P=0.00001) and lower levels of insulin (P=0.0001), c-peptide (0.0001). In the first year after diagnosis PR occurred in 62% patients. Individuals with DKA had lower PR incidence (24% vs 76% without DKA).

Conclusion: The prevalence of DKA is high in children from Wielkopolska. Children aged <4 years have the greatest risk of developing ketoacidosis. The highest frequency of severe DKA is related to symptoms’ duration and diabetes misdiagnosis. ZnT8 autoantibodies are associated with the worst general condition at the time of diagnosis.